Rupture and Perforation of the Esophagus

This chapter presents an overview of the pathophysiology, etiologies, diagnosis, and management of patients with esophageal perforation. Boerhaave syndrome, or effort rupture of the esophagus, describes a spontaneous, longitudinal perforation of the left posterolateral aspect of the distal esophagus due to a sudden increase in intraesophageal pressure, combined with negative intrathoracic pressure and/or failure of the cricopharyngeal muscle to relax. Iatrogenic perforation can occur during endoscopic procedures, esophageal intubation, and surgery. The clinical manifestations of an esophageal rupture or perforation vary by its etiology. Urgent surgical management remains the mainstay of treatment for the majority of patients with esophageal perforations and rupture to limit ongoing mediastinal contamination and manage the perforation site. Although esophageal perforation traditionally required surgical management, a modern, multidisciplinary approach that might involve endoscopic, interventional radiology, and surgical approaches is increasingly used.